Is Pediatric Telemedicine Contributing to Antibiotic Overuse in Kids?

Antibiotic overuse in pediatric telemedicine

Pediatric telemedicine greatly contributes to the delivery of pediatric healthcare, especially in remote, rural and underserved areas. However, a recent study raises concerns of inappropriate antibiotic prescribing during direct-to-consumer telemedicine pediatric visits.


  • Specializes in Clinical Leadership, Staff Development, Education. Has 30 years experience.
Antibiotic overuse in pediatric telemedicine

A recent study published in Pediatrics found that children with acute respiratory infections (ARIs) were more likely to receive antibiotics during a direct-to-consumer (DTC) telemedicine provider visit compared to those who visited their primary physician or urgent care center. Also, children were less likely to receive antibiotic care that followed clinical guidelines when the antibiotic was prescribed during a DTC telemedicine visit. The lead study author, Kristen Ray, MD, MS, raised concerns around the inappropriate use of antibiotics. Concerns include the potential side effects of antibiotic use and contributing to antibiotic resistance through overprescribing.

DTC Telemedicine Use Growing

There are several factors driving the rapid increase of DTC telemedicine use among children. The convenience factor is a big draw for busy parents, who are able to connect with a physician with their smartphone, tablet or other device capable of audio or audio-video conferencing. Adding to the convenience is the large number of commercial companies offering DTC telemedicine services. Also, millions of children now have access to DTC telemedicine with 96% of large business insurance plans offering coverage to their employees and families.

Quality of Care Concerns

There is limited evidence regarding the quality of care pediatric patients receive when utilizing a DTC telemedicine provider. However, there are significant differences in providing care to children through telemedicine when compared to adults. Children often have difficulty describing their symptoms, therefore, there is increased reliance on the physical assessment in gathering patient data. Providing services to pediatric patients requires knowledge and understanding of evidence based treatment guidelines. Children also have a higher need for guideline-concordant antibiotic management at physician visits.

Study Methods

The researchers examined 2015-2016 claims data from a large single commercial insurer providing coverage for approximately 4 million children. The insurer also had contracts with a national DTC telemedicine company. The study group included children, ages 0 to 17, who received a diagnosis of acute respiratory infection (ARI) during an urgent care, primary care or DCT telemedicine provider during their initial visit. The quality of antibiotic management of ARI for 4604 children diagnosed during DTC telemedicine visits was compared to 485,201 children diagnosed during primary care visits and 37,408 in urgent care visits. The researchers analyzed the data to determine if prescribed antibiotic therapy was appropriate or inappropriate for the patient’s condition.

Antibiotic therapy was considered “appropriate” treatment in the following ARIs:

  • Sinusitis
  • Pneumonia
  • Streptococcal pharyngitis
  • Acute otitis media

Antibiotic therapy was considered “inappropriate” treatment in the following diagnosis:

  • Viral upper respiratory infections
  • Bronchiolitis
  • Viral pharyngitis
  • Serous otitis media

Study Findings

The analysis revealed antibiotics were prescribed for 52% of children in DTC telemedicine visits compared to 42% in urgent care centers and 31% in primary care provider visits. Antibiotics were appropriately prescribed in 59% of the telemedicine visits, 67% in urgent care and 78% in primary care provider visits.

Antibiotics were inappropriately prescribed, primarily in cases of viral infections, in 56% of telemedicine visits compared to 67% of urgent care and 20% of primary care visits.

Limits of DTC Telemedicine

The researchers provide a discussion on potential reasons for increased antibiotic prescribing and lowered use of guidelines in DTC telemedicine visits.

  • Visits do not allow the same level of physical assessment as a face-to-face visit.
  • Technology is more limited compared to other types of telemedicine and more likely to have connection or sound issues.
  • Lack an established relationship and no access to the patient's medical record.
  • Provider may not have expertise specific to pediatrics

The study authors write “Together, these issues may increase clinical uncertainty during pediatric DTC telemedicine visits, prompting physicians to prescribe antibiotics ‘just to be safe.’”.

Study Limitations

The authors identified several limitations in the study’s data analysis.

  • Lack of additional demographic or clinical data, therefore, could not account for variables that could have influenced prescribing (race, severity of illness, time constraints or family expectations).
  • Analysis limited to a specific health plan and a single DTC telemedicine vendor


Telemedicine has a valuable place in healthcare delivery and its contribution will continue to grow. The technology allows pediatric patients in remote, rural and underserved communities to have greater access to care and specialty consultation. However, the study results do raise the question of limits of telemedicine in diagnosing ARIs and adequately manage antibiotic therapy in pediatric patients.

What do you think?

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Nurse with over 20 years experience with a career diverse in roles and settings. Enjoys writing about what she encounters during her own nursing practice.

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LibraSunCNM, MSN

1,617 Posts

Specializes in OB. Has 10 years experience.

My own anecdotal experience is that urgent care centers are just as bad with inappropriate antibiotic prescribing, for both peds and adults. I think the providers are pressured to "give people what they want," in a sense. Since it's not a PCP and people just go as needed, I don't think urgent cares want to disappoint patients or get a reputation for not doing anything, even if that's what's warranted. Probably similar with telemedicine.

Specializes in Critical Care, Med-Surg, Psych, Geri, LTC, Tele,.

I think tele medicine is great! My old HMO-Kaiser offered phone appts (similar to tele medicine) and I believe this promotes access.

However, I do NOT understand why ATB would be prescribed over the phone! You need to run lab tests to determine if the infection is present and whether it’s caused by bacteria.

overprescribing ATB = bad! ?

J.Adderton, BSN, MSN

167 Articles; 495 Posts

Specializes in Clinical Leadership, Staff Development, Education. Has 30 years experience.
10 hours ago, vintagemother said:

overprescribing ATB = bad! ?

I agree!